Disparities in Surgical Oncologic Care
non-CME
Isabel C. Yoon (she/her/hers)
Medical Student
Perelman School of Medicine, University of Pennsylvania
Philadelphia, Pennsylvania, United States
Disclosure information not submitted.
Isabel C. Yoon (she/her/hers)
Medical Student
Perelman School of Medicine, University of Pennsylvania
Philadelphia, Pennsylvania, United States
Disclosure information not submitted.
Stephany Perez-Rojas, MS
Biostatistician
Department of Surgery, Perelman School of Medicine, University of Pennsylvania, United States
Disclosure information not submitted.
Bhavya Ancha, BS
Medical Student
Perelman School of Medicine, University of Pennsylvania, United States
Disclosure information not submitted.
Leisha C. Elmore, MD, MPHS
Assistant Professor of Surgery
Hospital of the University of Pennsylvania, United States
Disclosure information not submitted.
Alina M. Mateo, MD, MS, FACS
Director of the Integrated Breast Center at Pennsylvania Hospital, Assistant Professor of Surgery
Pennsylvania Hospital, United States
Disclosure information not submitted.
Margaret S. Pichardo, MD, PhD, MPH
Resident Physician
Department of Surgery, Perelman School of Medicine, University of Pennsylvania,, United States
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Julia Tchou, MD PhD
Professor
University of Pennsylvannia
Wayne, Pennsylvania, United States
Disclosure information not submitted.
Jennifer Q. Zhang, MD
Assistant Professor of Surgery
Hospital of the University of Pennsylvania, United States
Disclosure information not submitted.
Rebecca A. Hubbard, PhD
Professor of Biostatistics
Department of Biostatistics, Epidemiology & Informatics, Perelman School of Medicine, University of Pennsylvania, United States
Disclosure information not submitted.
Oluwadamilola M. Fayanju, MD, MA, MPHS, FACS (she/her/hers)
The Helen O. Dickens Presidential Associate Professor & Chief, Division of Breast Surgery
The University of Pennsylvania / Penn Medicine
Philadelphia, Pennsylvania, United States
Disclosure information not submitted.
Neighborhood deprivation and associated sociodemographic factors impact breast cancer (BC) outcomes, but their effect in Philadelphia, the poorest large city in the US, is unclear. We sought to examine the associations of neighborhood deprivation and patient-level factors with stage at diagnosis (SDx) and to identify factors associated with time to treatment (TTT).
Methods:
In this retrospective cohort study at a single academic health system, we identified women ≥ 18 years old diagnosed with BC 2011-2019. Variables included age, race/ethnicity, insurance, clinical SDx, and area deprivation index (ADI). ADI scores were grouped into 4 levels using data binning: group 1=lowest ADI scores (least deprived) to group 4= highest ADI scores (most deprived). Advanced stage BC was defined as clinical stages 3 and 4. Logistic regression estimated associations of ADI and patient-level variables with SDx. In addition, influential predictors of TTT were identified using variable selection based on the Akaike Information Criterion (AIC).
Results:
11,108 women (non-Hispanic [NH] white=76.8%, NH Black=15.3%, Asian=4.1%, Hispanic=2.7%, other=1.2%) were included. NH white patients made up a higher proportion of the least deprived cohort (ADI 1=84.4%) and a lower proportion of the most deprived (ADI 4=50.9%), while the proportion of NH Black patients was higher in more deprived groups (ADI 1=3.9% vs ADI 4=41.5%). Patients in ADI 4 had higher odds of presenting with advanced SDx (OR=1.87, 95% CI 1.54-2.27, p< 0.001) compared to those in ADI 1 (reference). Patients identifying as NH Black had the highest odds of presenting with advanced SDx (OR=1.67, 95% CI=1.41-1.97, p< 0.001) vs NH white (reference). Uninsured (OR=2.11, 95% CI=1.22-3.48, p< 0.05) and Medicaid (OR=2.44, 95%CI=1.92-3.07, p< 0.001) patients had highest odds of presenting with advanced SDx vs those with private insurance (reference). Variables found to be predictive of TTT included race/ethnicity, age at diagnosis, SDx, ADI group, and insurance type. Specifically, values associated with greatest increase in TTT were being from the most deprived neighborhoods (i.e., ADI 3 and 4 vs ADI 1), identifying as NH Black (vs NH white), having Medicaid (vs private insurance), and having stage 1 BC (vs stage 0; see Table).
Conclusions:
After accounting for patient-level factors, high neighborhood deprivation was associated with advanced stage at diagnosis and prolonged TTT for women with BC in Philadelphia. Sustained investment in deprived neighborhoods may potentially mitigate disparities in diagnosis, treatment, and outcomes among individuals with breast cancer from those areas.